Take Care of Your Heart Before and After Problems

MONDAY Sept. 24, 2007 -- People need to take care of their heart both before and after heart trouble starts, two new studies suggest.

In the first study, researchers said that to avoid heart failure when you're 70 or 80, you must begin by keeping your blood pressure and weight under control when you're 50.

"We tested the hypothesis that higher levels of blood pressure and body mass index (BMI) in midlife would be powerful determinants of heart failure risk in later life, and that the risk posed by preceding measurements would remain even after accounting for these risk factors measured later in life," said lead researcher Dr. Ramachandran S. Vasan.

"This is exactly what we found," added Vasan, a senior investigator with the Framingham Heart Study and a professor of medicine at Boston University School of Medicine.

An increase of about 20 mm Hg in systolic blood pressure at age 50 was associated with a 36 percent higher risk of heart failure up to 20 years later. Every 2.2 pound increase in BMI (a ratio of weight to height) at age 50 was associated with a 6 percent increase in the risk of heart failure, Vasan said.

"The study highlights the importance of maintaining an ideal BMI and blood pressure over the life course of individuals," Vasan said.

For the study, Vasan's team collected data on 3,362 people who were part of the Framingham Heart Study who had routine examinations between 1969 and 1994. During follow-up, 518 people developed heart failure.

"The prevention of heart failure should begin early in life and should include screening for elevated blood pressure and BMI," Vasan said. "Failure to identify or treat such modifiable risk factors in early and mid-adulthood may result in the loss of opportunities to reduce the incidence of heart failure in later life."

The findings are published in the November issue of the journal Hypertension.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees that keeping both your weight and blood pressure down will help you avoid the ravages of heart failure.

"The lifetime risk for developing heart failure in both men and women is one in five," said Fonarow. "However, heart failure can be prevented, and there are a number of modifiable risk factors for heart failure, including hypertension, obesity, and diabetes.

"Maintaining a healthy blood pressure and body weight is essential to reduce the risk of heart failure," he said.

The second study found that fewer than 20 percent of patients seek cardiac rehabilitation after a heart attack or coronary bypass surgery.

"It has been shown by many trials that cardiac rehabilitation reduced the risk for new coronary events, re-hospitalization and mortality. The main advantage of cardiac rehabilitation is to reduce mortality," said study leader Dr. Jose A. Suaya, a lecturer and scientist at the Brandeis University Schneider Institutes for Health Policy, Heller School, in Waltham, Mass.

Cardiac rehabilitation also improves functional capacity, Suaya said. "Patients can walk more without pain and improve their quality of life," he said.

For the study, Suaya's group collected data on 267,427 men and women, 65 and older, who had survived a heart attack or bypass surgery. The data were drawn from 1997 Medicare claims records.

In the year after hospital discharge, only 18.7 percent of the patients had at least one session of cardiac rehabilitation. Patients who underwent bypass surgery were more likely to seek rehabilitation -- 31 percent -- compared with heart attack patients -- 13.9 percent.

More men had cardiac rehabilitation (22.1 percent) than women (14.3 percent). Age also played a role -- patients 75 to 85 were less likely to go for rehabilitation, the researchers found.

In addition, patients with other medical conditions, such as diabetes, a previous stroke, congestive heart failure or cancer, were significantly less likely to seek cardiac rehabilitation, Suaya's group found.

The study results are published in the Oct. 9 issue of the journal Circulation.

There are many reasons why patients don't seek rehabilitation, the researchers said.

"Many doctors may be reluctant to refer patients to cardiac rehabilitation," said study co-author Donald S. Shepard, a research professor at Brandeis' Heller School. "In addition, patients may not know or ask about it."

Shepard also noted that many medical institutions don't promote the service, which typically includes exercise and advice on diet. "It's not glamorous and, from the data we have, it is not very profitable," he said.

It may also be difficult for people to get to rehabilitation centers, Shepard said. "One of the findings in the study was that the closer you are, the more likely you are to use the service," he said. "Travel time and travel expense are things that reduce the use of the service."

Fonarow said "more needs to be done to ensure that eligible patients are effectively enrolled in supervised cardiac rehabilitation. The American Heart Association's 'Get With The Guidelines Program' is one example of a highly successful initiative to improve referral to cardiac rehabilitation after hospitalization for cardiovascular event or surgery."

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